重症肌无力患者胸腺CT与病理对照

目的探讨胸腺CT在胸腺疾病的诊断价值。方法对29例重症肌无力患者胸腺CT与胸腺病理结果进行对照研究。结果胸部腺CT对胸腺异常的正确诊断率89.66%,对胸腺增生、胸腺肿瘤的诊断敏感性分别为60%、88.89%。结论胸腺CT是诊断胸腺疾病的好方法,诊断的敏感性与胸腺疾病的性质关系密切。对于重症肌无力患者首选胸腺CT了解胸腺情况。     

以胸腺切除为主治疗重症肌无力的体会

重症肌无力是一种自身免疫性疾病，病变主要累及神经肌肉接头处突触后膜乙酰胆碱受体，表现为一组或多组骨骼肌异常疲劳无力。大量研究表明，重症肌无力的发病与胸腺关系密切，15％～30％合并胸腺增生或胸腺瘤。以往本病的治疗以药物为主，近年来，国内外开展以胸腺切除为主的综合治疗方法，疗效显著。2000～2002年，我们对22例重症肌无力患者进行以胸腺切除为主的综合治疗，体会如下。     

纤维胸腔镜与针吸肺活检和细胞学检查在诊断胸腔积液中的比较

大量报道表明,胸腔镜检查对胸腔积液的诊断率达90%左右,较针吸活检及脱落细胞学检查为优.本文研究目的在于评价纤维胸腔镜与 Abrams 针吸活检(活检)及脱落细胞学检查的优劣。研究对象及方法 28例胸腔积液患者,年龄在45～77岁,男26、女2例.渗出液蛋白浓度超过40g/L,其中16例经活检及细胞学检查为阴性。首先在局麻下进行活检;然后行胸腔引流液和脱落细胞学检查;最后胸腔镜检查。     

胸段食管癌切除术患者的预后分析

Objective To investigate the prognostic factors and influence of the number of lymph node metastases on survival and UICC-TNM classification in patients with thoracic esophageal cancer after curative resection. Methods From 1985 to 1990, 1224 patients were surgically treated for thoracic esophageal cancer. The patients who died within 30 days after operation were not included in this study. Fifteen factors possibly influencing survival of these patients were selected and analyzed. A multivariate analysis of these individual variables was performed by Cox proportional hazard model. According to the n, mher of lymph node metastases (0, 1 and ≥ 2), a new modification of the TNM classification was suggested: stage Ⅱ a (T2N0M0 and T3N0M0), stage Ⅱb [T1N1M0 and T2N1 (1) M0], stage Ⅲ a [T2N1 (2)M0 and T3N1 (1)M0] and stage Ⅲ b [T3N1 (2)M0 and T4NanyMO]. Results According to multivariate analysis, lymph node metastases, depth of invasion, location of tumor, histological classification and length of the tumor were of prognostic significance (P < 0.01). There was obvious correlation between the rate of lymph node metastasis and the depth of invasion, length of tumor and grade of differentiation. The 5-year survival rate of the patients with 0, 1 and ≥2 positive metastatic lymph nodes was 59.1%, 32.0% and 8.9%, respectively. The 5-year survival rate of the patients with stage T2N1M0 and stage T3N1M0 was significantly higher in those with only one lymph node involved than in those with two or more lymph nodes involved (43.1% vs. 18.0% and 28.0% vs. 9.6%, P<0.01). The 5-year survival rate of the modified stage Ⅱa, Ⅱb, Ⅲa and Ⅲb was56.5%, 43.9%, 25.6% and 11.1%, respectively, with a statistically significant difference among different stages (P < 0. 01). Conclusion The lymph node metastasis is the most important prognostic factor for thoracic esophageal cancer after resection. The major influencing factors of lymph node metastasis are the depth of invasion, length of tumor and grade of differentiation. Therefore, the lymphadenectomy along with esophngectomy and subsequently combined modality therapy against lymph node metastasis is necessary to improve the S-year survival rate. Our proposed new classification based on number of lymph node metastases (0, 1, ≥2 positive nodes) is more applicable because it can well reflect the correlation between lymph node metastasis and the survival, and provides evidence for the modification of the currently used UICC TNM staging system for surgically treated thoracic esophageal cancer.     

力尔凡胸腔内注射治疗癌性胸水的疗效观察

性胸水是晚期恶性胸部肿瘤的主要并发症,临床上以肺癌、恶性纵隔肿瘤、恶性胸膜间皮瘤等多见.胸水压迫肺脏导致呼吸困难,影响患者的生存质量.因此,控制胸水、缓解症状、提高患者生存质量是治疗晚期癌症并发胸水的主要目的.传统胸腔内注射化疗药物不良反应大,晚期衰竭患者难以耐受.2002年5月-2005年5月,本院应用力尔凡联合卡铂治疗癌性胸水患者,取得良好效果,现报道如下.     

胸段食管癌切除术患者的预后分析

Objective To investigate the prognostic factors and influence of the number of lymph node metastases on survival and UICC-TNM classification in patients with thoracic esophageal cancer after curative resection. Methods From 1985 to 1990, 1224 patients were surgically treated for thoracic esophageal cancer. The patients who died within 30 days after operation were not included in this study. Fifteen factors possibly influencing survival of these patients were selected and analyzed. A multivariate analysis of these individual variables was performed by Cox proportional hazard model. According to the n, mher of lymph node metastases (0, 1 and ≥ 2), a new modification of the TNM classification was suggested: stage Ⅱ a (T2N0M0 and T3N0M0), stage Ⅱb [T1N1M0 and T2N1 (1) M0], stage Ⅲ a [T2N1 (2)M0 and T3N1 (1)M0] and stage Ⅲ b [T3N1 (2)M0 and T4NanyMO]. Results According to multivariate analysis, lymph node metastases, depth of invasion, location of tumor, histological classification and length of the tumor were of prognostic significance (P < 0.01). There was obvious correlation between the rate of lymph node metastasis and the depth of invasion, length of tumor and grade of differentiation. The 5-year survival rate of the patients with 0, 1 and ≥2 positive metastatic lymph nodes was 59.1%, 32.0% and 8.9%, respectively. The 5-year survival rate of the patients with stage T2N1M0 and stage T3N1M0 was significantly higher in those with only one lymph node involved than in those with two or more lymph nodes involved (43.1% vs. 18.0% and 28.0% vs. 9.6%, P<0.01). The 5-year survival rate of the modified stage Ⅱa, Ⅱb, Ⅲa and Ⅲb was56.5%, 43.9%, 25.6% and 11.1%, respectively, with a statistically significant difference among different stages (P < 0. 01). Conclusion The lymph node metastasis is the most important prognostic factor for thoracic esophageal cancer after resection. The major influencing factors of lymph node metastasis are the depth of invasion, length of tumor and grade of differentiation. Therefore, the lymphadenectomy along with esophngectomy and subsequently combined modality therapy against lymph node metastasis is necessary to improve the S-year survival rate. Our proposed new classification based on number of lymph node metastases (0, 1, ≥2 positive nodes) is more applicable because it can well reflect the correlation between lymph node metastasis and the survival, and provides evidence for the modification of the currently used UICC TNM staging system for surgically treated thoracic esophageal cancer.     

胸腺病变相关重症肌无力手术治疗体会

重症肌无力 (MG)是一种全身性自身免疫性疾病 ,其临床表现以骨骼肌受侵害为主 ,发病机制目前还不十分明确。重症肌无力往往合并胸腺病变 ,有资料报道约 80 %重症肌无力合并胸腺病变 ,其中 80 %为胸腺增生 ,2 0 %为胸腺瘤[1 ] 。自 1999年 1月至 2 0 0 2年 6月 ,我们共收治重症肌无力患者 2 3例 ,现将手术治疗体会报告如下。1　临床资料1.1　 2 3例患者术前均具备完整的影像学资料 ,证实合并有胸腺病变。男 10例 ,女 13例 ;年龄 2～ 67岁 ,平均 ( 3 3 .71± 1.2 4)岁 ,病程 1个月～ 11年 ,中位数 5 .7月。1.2　CT检查　所有病例均经胸部CT…     

胸段食管癌切除术患者的预后分析

Objective To investigate the prognostic factors and influence of the number of lymph node metastases on survival and UICC-TNM classification in patients with thoracic esophageal cancer after curative resection. Methods From 1985 to 1990, 1224 patients were surgically treated for thoracic esophageal cancer. The patients who died within 30 days after operation were not included in this study. Fifteen factors possibly influencing survival of these patients were selected and analyzed. A multivariate analysis of these individual variables was performed by Cox proportional hazard model. According to the n, mher of lymph node metastases (0, 1 and ≥ 2), a new modification of the TNM classification was suggested: stage Ⅱ a (T2N0M0 and T3N0M0), stage Ⅱb [T1N1M0 and T2N1 (1) M0], stage Ⅲ a [T2N1 (2)M0 and T3N1 (1)M0] and stage Ⅲ b [T3N1 (2)M0 and T4NanyMO]. Results According to multivariate analysis, lymph node metastases, depth of invasion, location of tumor, histological classification and length of the tumor were of prognostic significance (P < 0.01). There was obvious correlation between the rate of lymph node metastasis and the depth of invasion, length of tumor and grade of differentiation. The 5-year survival rate of the patients with 0, 1 and ≥2 positive metastatic lymph nodes was 59.1%, 32.0% and 8.9%, respectively. The 5-year survival rate of the patients with stage T2N1M0 and stage T3N1M0 was significantly higher in those with only one lymph node involved than in those with two or more lymph nodes involved (43.1% vs. 18.0% and 28.0% vs. 9.6%, P<0.01). The 5-year survival rate of the modified stage Ⅱa, Ⅱb, Ⅲa and Ⅲb was56.5%, 43.9%, 25.6% and 11.1%, respectively, with a statistically significant difference among different stages (P < 0. 01). Conclusion The lymph node metastasis is the most important prognostic factor for thoracic esophageal cancer after resection. The major influencing factors of lymph node metastasis are the depth of invasion, length of tumor and grade of differentiation. Therefore, the lymphadenectomy along with esophngectomy and subsequently combined modality therapy against lymph node metastasis is necessary to improve the S-year survival rate. Our proposed new classification based on number of lymph node metastases (0, 1, ≥2 positive nodes) is more applicable because it can well reflect the correlation between lymph node metastasis and the survival, and provides evidence for the modification of the currently used UICC TNM staging system for surgically treated thoracic esophageal cancer.     

低龄儿胸腺增生伴眼肌型肌无力胸腺切除术后疗效的观察

目的观察低龄重症肌无力(MG)患儿摘除胸腺后对患儿的影响。方法总结近6a内因眼肌型MG并胸腺增生行扩大胸腺摘除后效果及对患儿生长发育的影响进行追踪观察。结果扩大胸腺摘除术对重症肌无力的治疗临床缓解率高,对患儿生长发育无明显影响,患儿外周淋巴细胞亚群指标可基本恢复正常。结论对低龄患儿眼肌型MG行胸腺扩大摘除术是一个有效方法之一。     

支架治疗食管肿瘤所致进食功能障碍

目的评价置入自膨覆膜支架治疗食管、贲门恶性狭窄所致进食功能障碍康复的疗效。方法对41例食管、贲门恶性狭窄患者行食管内支架治疗,透视下用胃管引导导丝通过狭窄部位,再沿导丝插入支架置入器,定位准确后推放。结果置入操作顺利35例(15min内),6例在20～40min内完成,无术中并发症。术后常见反应为胸骨后胀痛,一般可耐受。术后所有患者吞咽困难症状明显改善,一般状态好转。结论支架是治疗食管、贲门恶性狭窄所致进食功能障碍康复的一种安全有效的方法。有可能代替空肠造瘘术、胃转流术,成为主要的姑息性康复治疗方法。